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The influence of timing of radiation therapy following breast-conserving surgery on 10-year disease-free survival
BACKGROUND: The Dutch guidelines advise to start radiation therapy (RT) within 5 weeks following breast-conserving surgery (BCS). However, much controversy exists regarding timing of RT. This study investigated its effect on 10-year disease-free survival (DFS) in a Dutch population-based cohort. MET...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Nature Publishing Group
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5520509/ https://www.ncbi.nlm.nih.gov/pubmed/28588320 http://dx.doi.org/10.1038/bjc.2017.159 |
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author | van Maaren, Marissa C Bretveld, Reini W Jobsen, Jan J Veenstra, Renske K Groothuis-Oudshoorn, Catharina GM Struikmans, Hendrik Maduro, John H Strobbe, Luc JA Poortmans, Philip MP Siesling, Sabine |
author_facet | van Maaren, Marissa C Bretveld, Reini W Jobsen, Jan J Veenstra, Renske K Groothuis-Oudshoorn, Catharina GM Struikmans, Hendrik Maduro, John H Strobbe, Luc JA Poortmans, Philip MP Siesling, Sabine |
author_sort | van Maaren, Marissa C |
collection | PubMed |
description | BACKGROUND: The Dutch guidelines advise to start radiation therapy (RT) within 5 weeks following breast-conserving surgery (BCS). However, much controversy exists regarding timing of RT. This study investigated its effect on 10-year disease-free survival (DFS) in a Dutch population-based cohort. METHODS: All women diagnosed with primary invasive stage I-IIIA breast cancer in 2003 treated with BCS+RT were included. Two populations were studied. Population 1 excluded patients receiving chemotherapy before RT. Analyses were stratified for use of adjuvant systemic therapy (AST). Population 2 included patients treated with chemotherapy, and compared chemotherapy before (BCS-chemotherapy-RT) and after RT (BCS-RT-chemotherapy). DFS was estimated using multivariable Cox regression. Locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS) and overall survival (OS) were secondary outcomes. RESULTS: Population 1 (n=2759) showed better DFS and DMFS for a time interval of >55 than a time interval of <42 days. Patients treated with AST showed higher DFS for >55 days (hazards ratio (HR) 0.60 (95% confidence interval (CI): 0.38–0.94)) and 42–55 days (HR 0.64 (95% CI: 0.45–0.91)) than <42 days. Results were similar for DMFS, while timing did not affect LRRFS and OS. For patients without AST, timing was not associated with DFS, DMFS and LLRFS, but 10-year OS was significantly lower for 42–55 and >55 days compared to <42 days. In population 2 (n=1120), timing did not affect survival in BCS-chemotherapy-RT. In BCS-RT-chemotherapy, DMFS was higher for >55 than <42 days. CONCLUSIONS: Starting RT shortly after BCS seems not to be associated with a better long-term outcome. The common position that RT should start as soon as possible following surgery in order to increase treatment efficacy can be questioned. |
format | Online Article Text |
id | pubmed-5520509 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Nature Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-55205092018-07-11 The influence of timing of radiation therapy following breast-conserving surgery on 10-year disease-free survival van Maaren, Marissa C Bretveld, Reini W Jobsen, Jan J Veenstra, Renske K Groothuis-Oudshoorn, Catharina GM Struikmans, Hendrik Maduro, John H Strobbe, Luc JA Poortmans, Philip MP Siesling, Sabine Br J Cancer Clinical Study BACKGROUND: The Dutch guidelines advise to start radiation therapy (RT) within 5 weeks following breast-conserving surgery (BCS). However, much controversy exists regarding timing of RT. This study investigated its effect on 10-year disease-free survival (DFS) in a Dutch population-based cohort. METHODS: All women diagnosed with primary invasive stage I-IIIA breast cancer in 2003 treated with BCS+RT were included. Two populations were studied. Population 1 excluded patients receiving chemotherapy before RT. Analyses were stratified for use of adjuvant systemic therapy (AST). Population 2 included patients treated with chemotherapy, and compared chemotherapy before (BCS-chemotherapy-RT) and after RT (BCS-RT-chemotherapy). DFS was estimated using multivariable Cox regression. Locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS) and overall survival (OS) were secondary outcomes. RESULTS: Population 1 (n=2759) showed better DFS and DMFS for a time interval of >55 than a time interval of <42 days. Patients treated with AST showed higher DFS for >55 days (hazards ratio (HR) 0.60 (95% confidence interval (CI): 0.38–0.94)) and 42–55 days (HR 0.64 (95% CI: 0.45–0.91)) than <42 days. Results were similar for DMFS, while timing did not affect LRRFS and OS. For patients without AST, timing was not associated with DFS, DMFS and LLRFS, but 10-year OS was significantly lower for 42–55 and >55 days compared to <42 days. In population 2 (n=1120), timing did not affect survival in BCS-chemotherapy-RT. In BCS-RT-chemotherapy, DMFS was higher for >55 than <42 days. CONCLUSIONS: Starting RT shortly after BCS seems not to be associated with a better long-term outcome. The common position that RT should start as soon as possible following surgery in order to increase treatment efficacy can be questioned. Nature Publishing Group 2017-07-11 2017-06-06 /pmc/articles/PMC5520509/ /pubmed/28588320 http://dx.doi.org/10.1038/bjc.2017.159 Text en Copyright © 2017 Cancer Research UK http://creativecommons.org/licenses/by-nc-sa/4.0/ From twelve months after its original publication, this work is licensed under the Creative Commons Attribution-NonCommercial-Share Alike 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/ |
spellingShingle | Clinical Study van Maaren, Marissa C Bretveld, Reini W Jobsen, Jan J Veenstra, Renske K Groothuis-Oudshoorn, Catharina GM Struikmans, Hendrik Maduro, John H Strobbe, Luc JA Poortmans, Philip MP Siesling, Sabine The influence of timing of radiation therapy following breast-conserving surgery on 10-year disease-free survival |
title | The influence of timing of radiation therapy following breast-conserving surgery on 10-year disease-free survival |
title_full | The influence of timing of radiation therapy following breast-conserving surgery on 10-year disease-free survival |
title_fullStr | The influence of timing of radiation therapy following breast-conserving surgery on 10-year disease-free survival |
title_full_unstemmed | The influence of timing of radiation therapy following breast-conserving surgery on 10-year disease-free survival |
title_short | The influence of timing of radiation therapy following breast-conserving surgery on 10-year disease-free survival |
title_sort | influence of timing of radiation therapy following breast-conserving surgery on 10-year disease-free survival |
topic | Clinical Study |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5520509/ https://www.ncbi.nlm.nih.gov/pubmed/28588320 http://dx.doi.org/10.1038/bjc.2017.159 |
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